Screening for Cushing’s Syndrome in Obese Patients

Abstract

OBJECTIVES:The aim of this study was to examine the frequency of Cushing’s syndrome (CS) in obese patients devoid of specific clinical symptoms of Cushing’s syndrome.METHODS:A total of 150 obese patients (129 female, 21 male; mean age 44.41 ± 13.34 yr; mean BMI 35.76 ± 7.13) were included in the study. As a first screening step, we measured 24-h urinary free cortisol (UFC). An overnight 1-mg dexamethasone suppression test was also performed on all patients. Urinary free cortisol levels above 100 μg/24 h were considered to be abnormal. Suppression of serum cortisol <1.8 μg/dL after administration of 1 mg dexamethasone was the cut-off point for normal suppression. The suppression of the serum cortisol levels failed in all of the patients.RESULTS:Measured laboratory values were as follows: ACTH, median level 28 pg/ml, interquartile range (IQR) 14–59 pg/ml; fasting glucose, 100 (91–113) mg/dL; insulin, 15.7 (7.57–24.45) mU/ml; fT4, 1.17 (1.05–1.4) ng/dL; TSH, 1.70 (0.91–2.90) mIU/L; total cholesterol, 209 (170.5–250) mg/dL; LDL-c, 136 (97.7–163) mg/dL; HDL-c, 44 (37.25–50.75) mg/dL; VLDL-c, 24 (17–36) mg/dL; triglycerides, 120.5 (86–165) mg/dL. The median UFC level of the patients was 30 μg/24 h (IQR 16–103). High levels of UFC (>100 μg/24 h) were recorded in 37 patients (24%). Cushing’s syndrome was diagnosed in 14 of the 150 patients (9.33%). Etiologic reasons for Cushing’s syndrome were pituitary microadenoma (9 patients), adrenocortical adenoma (3 patients), and adrenocortical carcinoma (1 patient).CONCLUSION:A significant proportion (9.33%) of patients with simple obesity were found to have Cushing’s syndrome. These findings argue that obese patients should be routinely screened for Cushing’s syndrome.

Prevalence of Endocrine Disorders in Morbidly Obese Patients and the Effects of Bariatric Surgery on Endocrine and Metabolic Parameters

“…Recent evidence has revealed a high prevalence of endogenous CS (1-5%) in certain patient populations, particularly in subjects with uncontrolled diabetes and/or hypertension, as well as osteoporosis [10][11][12]. Another current study reported a prevalence of CS of up to 9.3% in obese patients [13].…”

Epidemiology of hyperadrenocorticism among 210,824 dogs attending primary‐care veterinary practices in the UK from 2009 to 2014

“…It is possible that dogs with higher average bodyweight are more likely to be overweight and therefore these results may suggest that overweight/obesity may be associated with hyperadrenocorticism in dogs. Previous reports have also suggested that dogs with a higher body condition score were at higher risk of hyperadrenocorticism than dogs with normal or low body condition scores, and an association between obesity and increased hyperadrenocorticism risk is recognised in human medicine (Lund et al, 2006, Tiryakioglu et al, 2010. However, these earlier studies reported associations rather than causal relationships and there are clearly other possible non-causal explanations for this association.…”

Routine screening for Cushing's syndrome is not required in patients presenting with hirsutism

“…Screening studies for obese populations usually revealed a low prevalence of CS except for one study that found a prevalence of 9% (6,31,32,33). Moreover, false-positivity rate was found to be 25%, which resulted in unnecessary further investigations (6).…”